Thursday, January 7, 1999 Published at 08:11 GMTHealthAbuse blamed for some cot deathsThere are 500 cot deaths a year, according to cot death charitiesA small number of babies who have been diagnosed as dying from cot death may actually have been the victims of child abuse, a leading expert has warned.

Professor Sir Roy Meadow says the term Sudden Infant Death Syndrome (SIDS) or cot death should be revised or abandoned. He suggests replacing it with "unexplained" or "undetermined".

"SIDS has been used, at times, as a pathological diagnosis to evade awkward truths," he said.

Sudden child deaths need more investigation, says Sir Roy

He added that the media portrayal of SIDS made it seem as if there was one cause for it when it just means that an infant has died suddenly and their death is a mystery.

About one baby in every 500 dies from cot death, making it one of the commonest causes of death among young infants.

Studies have variously linked cot deaths to the practice of putting babies to sleep on their stomachs, or to smoking in pregnancy and around the newborn baby, over-warm rooms and low birth weight.

Smothering

Sir Roy, a child abuse expert from St James's University Hospital in Leeds, examined the records of 81 children who had been found by courts to have been killed by their parents over an 18-year period.

Forty-nine had initially been certified to have died of SIDS and 29 others were said to have died of natural causes.

In over 80% of cases the mother had been judged to have killed the child, usually by smothering. Most of the deaths occurred in deprived households. Five of the children were over a year old and two had fractured ribs.

In 18 cases, two children had been killed in the same family. In five families, three had been killed and in one four had died.

Up to 27 children were found with blood in the mouth, nose, or
on the face, and 10 had unusual bruises on the face and neck.
Some had foreign objects, coins or balls of paper in their airways or intestines.

National scandal

Sir Roy called for much more to be done to investigate unexplained child deaths and said it was "a national scandal" that so many unexplained deaths were accepted.

Sudden child deaths need more investigation, says Sir Roy

"In the past, infant deaths were much more common and the numbers were too large for people to have the resources to investigate them all," he said.

"Now there are under 400 cases a year so there are very strong grounds for each case to be carefully assessed by pathologists, paediatricians and others and for them to visit the scene of the death."

Sir Roy said the reason most of the deaths he studied were caused by mothers may be because women were more likely to kill their children in a more premeditated way than men.

Post natal depression was a factor in a handful of the 81 cases, he added.

Protection

Sir Roy's research, published in the Archives of Disease in Childhood, is backed by the NSPCC, which called for more detailed investigations into sudden child deaths.

Sir Roy Meadow claims cot death is a misleading term

"Many infant deaths are complete tragedies, but a small minority are a result of abuse, whether through parental action or inaction. We have to think of protecting any surviving children," a spokeswoman said.

But the Foundation for the Study of Infant Deaths said Sir Roy's study was not representative of a typical paediatrician because he had a particular interest in unnatural child deaths.

It said there had been nearly 25,000 cot deaths over the 18 years covered by Sir Roy's study.

"It would be unfair to exacerbate the pain of cot death parents by casting general suspicion on their tragedy," it said in a statement.

However, it agreed that all unexpected infant deaths should be properly investigated and have funded training of paediatric pathologists.

Unlike Sir Roy, it believes the term SIDS should be kept, but should be used "consistently and correctly" and should be linked to thorough post mortems.

It repeated a call for better support for vulnerable families and more research into SIDS.